PLWH can safely take immunomodulatory drugs (IMDs), but viral blips are more likely, a retrospective cohort study published in AIDS showed.
The study analyzed data on 77 PLWH who experienced a total of 110 treatment episodes in which they received medications that affect the immune system. (Such drugs are usually prescribed for autoimmune, non-HIV inflammatory, and oncologic conditions.) In 51 of those episodes, the person began taking IMDs while their viral load was undetectable. Over the next year, no virologic failures occurred, but in 21 episodes (41%) the person experienced a viral load blip—usually to a level that was still below 200 copies/mL.
Viral blips were especially likely in participants who had been prescribed checkpoint inhibitors. That type of drug can reverse HIV latency, which may explain that result, the authors wrote.
While most participants were on antiretroviral therapy when they started immunomodulatory treatment, two people were living with undiagnosed HIV and four participants seroconverted while taking IMDs. The cohort also included four elite controllers—i.e., people whose HIV viral load remains suppressed in the absence of antiretroviral treatment.
Study authors called for further research into this topic, including an HIV-negative control group. Meanwhile, they recommended that providers do the following before starting immunomodulatory treatment:
- Test for HIV.
- Counsel PLWH about the limited safety data available.
- Test patients with HIV for tuberculosis and viral hepatitis.
- Consult with the patient’s HIV care providers.
In addition, once the immunomodulatory medication has been prescribed, providers should monitor quarterly viral load results and consult with a patient’s HIV provider if necessary, the authors wrote. If people seroconvert while on immunomodulatory drugs, they should be referred to an HIV provider to start antiretroviral therapy promptly.